{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:04:30Z","timestamp":1792109070500,"version":"4.4.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Spinal deformity surgery is associated with significant blood loss, often requiring the transfusion of blood and\/or blood products. For patients declining blood or blood products, even in the face of life-threatening blood loss, spinal deformity surgery has been associated with high rates of morbidity and mortality. For these reasons, patients for whom blood transfusion is not an option have historically been denied spinal deformity surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively reviewed a prospectively collected data set. All patients declining blood transfusion who underwent spinal deformity surgery at a single institution between January 2002 and September 2021 were identified. Demographics collected included age, sex, diagnosis, details of any prior surgery, and medical comorbidities. Perioperative variables included levels decompressed and instrumented, estimated blood loss, blood conservation techniques used, length of surgery, length of hospital stay, and complications from surgery. Radiographic measurements included, where appropriate, sagittal vertical axis correction, Cobb angle correction, and regional angular correction.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Spinal deformity surgery was performed in 31 patients (18 male, 13 female) over 37 admissions. The median age at surgery was 41.2 years (range 10.9\u201370.1 years), and 64.5% had significant medical comorbidities. A median of 9 levels (range 5\u201316 levels) were instrumented per surgery, and the median estimated blood loss was 800 mL (range 200\u20133000 mL). Posterior column osteotomies were performed in all surgeries, and pedicle subtraction osteotomies in 6 cases. Multiple blood conservation techniques were used in all patients. Preoperative erythropoietin was administered prior to 23 surgeries, intraoperative cell salvage was used in all, acute normovolemic hemodilution was performed in 20, and perioperative administration of antifibrinolytic agents was performed in 28 surgeries. No allogenic blood transfusions were administered. Surgery was staged intentionally in 5 cases, and there was 1 unintended staging due to intraoperative blood loss from a vascular injury. There was 1 readmission for a pulmonary embolus. There were 2 minor postoperative complications. The median length of stay was 6 days (range 3\u201328 days). Deformity correction and the goals of surgery were achieved in all patients. Two patients underwent revision surgery during the follow-up period: one for pseudarthrosis and the other for proximal junctional kyphosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>With proper preoperative planning and judicious use of blood conservation techniques, spinal deformity surgery may be performed safely in patients for whom blood transfusion is not an option. The same techniques can be applied widely to the general population in order to minimize blood loss and the need for allogeneic blood transfusion.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.11.spine221061","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T08:32:34Z","timestamp":1671179554000},"page":"348-356","source":"Crossref","is-referenced-by-count":8,"title":["Spinal deformity surgery in patients for whom blood transfusion is not an option: a single-center experience"],"prefix":"10.3171","volume":"38","author":[{"given":"Alexander J.","family":"Schupper","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margit","family":"Kaufman","sequence":"additional","affiliation":[{"name":"and Departments of Anesthesiology and Critical Care Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay S.","family":"Reidler","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Mount Sinai Health System, New York, New York;"},{"name":"Orthopaedic Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc S.","family":"Arginteanu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurosurgery, Englewood Health, Englewood, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank M.","family":"Moore","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurosurgery, Englewood Health, Englewood, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Steinberger","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurosurgery, Englewood Health, Englewood, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar N.","family":"Syed","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurosurgery, Englewood Health, Englewood, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Yao","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurosurgery, Englewood Health, Englewood, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakov","family":"Gologorsky","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Neurosurgery, Englewood Health, Englewood, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"21","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"2310","article-title":"Blood conservation techniques in spinal deformity surgery: a retrospective review of patients refusing blood transfusion","volume":"33","author":"Joseph SA Jr","year":"2008","unstructured":"Joseph SA Jr, Berekashvili K, Mariller MM,  Blood conservation techniques in spinal deformity surgery: a retrospective review of patients refusing blood transfusion. 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